Pink ribbons, pink t-shirts, pink tow trucks, pink water in public fountains. October is breast cancer awareness month, but for many organizations, awareness programs are more about optics than outcomes. Getting consistently screened for breast cancer (and performing self-checks) is important: the earlier the cancer is caught, the more treatable and survivable it is. But even the healthcare industry tends to focus their awareness programs on cisgender women of a certain age, class, race, and shape. It’s time for a more inclusive approach.
The primary risk factors for breast cancer are having breast cells that are responsive to hormones and having estrogen in your body. All humans are born with some breast tissue and almost all human bodies produce some estrogen.
This means practically everyone has some risk.
- Cisgender women are at highest risk. Among racial groups, Black and white patients both have a high level of risk, but Black women are likely to face obstacles to care caused by racism, such as the wealth gap between Black and white people.
- Intersex people, nonbinary people, transwomen who take estrogen, and transmen who have not had a masectomy all have some risk. They also tend to face more issues with healthcare access than cisgender people, which heightens their risk and mortality rates.
- Cisgender men are at much lower risk than other groups. But even though less than 1% of all breast cancer diagnoses are in cisgender men, these patients tend to have higher mortality rates because they don’t recognize the signs and delay seeking treatment.
Of course there are many other risk factors, as well.
- Having a BRCA gene mutation. These mutations affect genes that suppress tumors.
- Having a first-, second-, or third-degree relative with a BRCA mutation. People of Ashkenazi Jewish descent are at particularly high risk for these mutations.
- Having a family history of breast cancer or ovarian cancer.
- Having radiation therapy between the ages of 10 and 30.
This is why awareness programs need to be inclusive. If patients don’t know their risk level, they won’t seek cancer screenings.
Obstacles to Care
Awareness isn’t enough, though. Patients need to have access to cancer screenings, cancer hospitals, high-quality care, and ongoing care once they are in remission. But obstacles abound.
We’ve discussed obstacles to adherence many times in the past, and in the case of breast cancer screenings or cancer care, they’re no different.
- Barriers of environment: stigma; patient feels embarrassment about pursuing care or has had negative healthcare experiences in the past
- Barriers of situation: patient is uninsured, impoverished, homebound, lacks transportation, needs physical assistance, or has a language barrier
- Barriers of time: patient has too many other responsibilities that make it difficult to schedule or attend medical appointments
- Barriers of place: patient has no geographic access to services that they need
That last point is particularly relevant. Last year, the GoodRx research team wrote a white paper about healthcare deserts. They found that 20% of US counties are hospital deserts, where people have limited or no access to a hospital. Many of these deserts are in rural areas. As a result, breast cancer patients in rural areas are less likely to be diagnosed early and more likely to die of their illness.
There have been some efforts to improve access for patients in need. Low-cost and free breast cancer screenings are available for uninsured patients with a yearly income of 250% or less of the federal poverty level. Medicare Part B covers annual and medically-necessary mammograms. As of 2016, all state Medicaid programs cover mammograms but may not cover genetic screening or preventative medications and services.
Clearly, there is much more to be done to improve access and care for everyone affected by breast cancer.
How to Help
Think before you buy. When presented with a pink product that claims to support breast cancer awareness, follow the money. Is the money going to a legitimate organization? What percent of profits is going to cancer research or to support patients?
This includes the donations you’re asked to make at the cash register of many major retailers. It’s hard not to give in automatically when asked, “Would you like to make a donation to breast cancer awareness/research?” If you’d like to donate in that situation, ask where your money will go. Or donate on your own to cancer research or support a small business run by a cancer survivor.
Helping spread breast cancer awareness doesn’t have to entail money, though. If you’re tasked with developing an awareness program, insist on inclusive language. Don’t rely on stock photos of slim, white, young, cisgender women. Don’t try to make this disease sexy. It’s a serious illness with devastating consequences for millions of families.
Speaking of family: talk to your family, friends, and community about their cancer risks. Do what you can to share information about breast cancer, provide transportation to mammogram appointments, or support a current cancer patient or survivor.
Take care of yourself, too. Talk to your doctor about when to start getting mammograms. Monitor your body for the following changes, and talk to your doctor if you notice anything unusual.
- Pain in your breast/chest area
- Changes in the shape, size, or texture of your breast/chest
- Nipple discharge
- Lumps in your breast/chest area, from your underarm to your collarbone
Breast cancer knows no gender and no boundaries. Not only should the messaging around this illness be inclusive and wide-ranging, but healthcare organizations should also focus on improving patients’ access to care.
Uninsured people are less likely to get cancer screenings. People of color are often underemployed or underpaid and thus underinsured, limiting their access to mammograms or genetic testing. LGBTQ+ people may not be able to receive insurance through a partner, or may find it difficult to get a cancer screening, especially if they are intersex or trans. People who live in healthcare deserts and rural areas might have little access to services at all.
Ultimately, patients can take control of their own health to some extent. But the healthcare industry has a lot of work to do to improve access and care for all.